LARGE VOLUME PARACENTESIS IN THE MANAGEMENT OF ASCITES IN THE PEDIATRIC POPULATION

Abstract

86 Large volume paracentesis (LVP) has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. However, there are no published data relating to the safety, efficacy or methods of LVP in children. Our aim in this study was to characterize our experience in LVP for management of liver-disease associated ascites. Methods: Retrospective chart review was performed of 13 LVP sessions in 4 children with liver disease and tense ascites that did not respond to other measures. LVP was defined as removal of ≥ 10 cc/kg. Data reviewed included the volume and duration of LVP, use of ultrasound guidance, needle type, complications, use of i.v. albumin, ascitic fluid analysis and coagulation status of patients. Results: Patients were 4 children (ages 6 months to 17 years) with portal hypertension from chronic liver allograft rejection, Budd-Chiari syndrome, congenital hepatic fibrosis, or cirrhosis after trisegmentectomy for hepatoblastoma. Mean volume removed was 4572 ± 3015 ml (mean ± SD) or 76.1 ± 47.02 cc/kg over 5.5 ± 3.1 hours by a 16 gauge angiocath needle in 12 sessions and a 15 gauge Caldwell paracentesis needle in 1. Nine LVP's (69%) were ultrasound guided. Ascitic absolute neutrophil count was > 250/mm3 in 5 (39%). Cultures were negative in all, but 4 (31%) were treated for spontaneous bacterial peritonitis. I.V. albumin (mean dose 0.9 gm/kg) was given in 11 (85%) during LVP. Prothrombin time was normal in 1 patient (9%), 1-5 seconds above normal in 4 patients (36%), and > 5 seconds above normal in 6 patients (55%). Four patients (31%) received FFP prior to LVP. Complications encountered were hypotension in 1 (8%) and decreased urine output in 2 (15%); no significant hemorrhage was observed. Conclusions: LVP is a safe and effective therapeutic modality for managing tense abdominal ascites in children. Hypotension and decreased urine output were complications rarely encountered and were readily managed with volume expansion. The use of albumin infusion, the need to correct coagulopathy, and new needles specifically designed for LVP in children require further investigation.